Among the top targets for abuse in the pharma craze is the painkiller fentanyl. The April overdose death of pop music icon Prince thrust the prescription opioid into the spotlight. And as the opioid epidemic continues its sweep across the nation, prescription fentanyl, counterfeit fentanyl and fentanyl-containing concoctions are killing users, warns the United States Drug Enforcement Administration (DEA), and the bodies are piling up even as the federal government and law enforcement entities strive to stem the tide.

“Kids are dying,” Molfino asserted. “Drug dealers are selling fentanyl as heroin or combining it with heroin and selling it to users, and people are overdosing.”

But heroin is not the only guise fentanyl takes outside of its typical forms. It is being found as near as Houston in fake pharmaceuticals, masked as Xanax, Norco or even the painkiller Oxycontin, which is itself often referred to as “hillbilly heroin.”

In August, the Houston Forensic Science Center (HFSC) reported its analysts had discovered the presence of fentanyl in counterfeit pharmaceuticals and powders 10 times so far in 2016. Eight of the 10 incidents involved fake pharmaceuticals.

“Fentanyl and fentanyl derivatives are dangerous because they are more lethal than other illicit drugs,” reports HFSC. “The fake pharmaceuticals laced with fentanyl … can be particularly dangerous because the user believes they are buying a legitimate pharmaceutical without a prescription … and overdose because they are unaware the fake pill contains fentanyl.”

Already a powerful drug, fentanyl is a schedule II synthetic opioid analgesic that is 50 times more potent than heroin and 100 times more potent than morphine, reports the CDC. Pharmaceutical fentanyl is primarily prescribed to manage acute and chronic pain associated with advanced cancer, while non-pharmaceutical fentanyl is illegally made and is often mixed with heroin and/or cocaine, with or without the user’s knowledge, in order to increase the drug’s effect. In its prescription form, fentanyl is known by such names as Actiq, Duragesic and Sublimaze. Street names for fentanyl or for fentanyl-laced heroin include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, and Tango and Cash.

Between August 2013 and the end of 2015, states the HFSC, U.S. law enforcement agencies have seized at least 239 kilograms of illicitly produced fentanyl, and 700 fentanyl-related deaths occurred in the United States between late 2013 and late 2014.

In October 2016, officers in Lubbock arrested four people reportedly related to a fentanyl distribution ring after a SWAT team found the majority of a 300-gram shipment of fentanyl from China. Investigators say the ringleader ordered the drugs from China and used a pill press to create fake pharmaceuticals distributed throughout the city. Police believe the group is responsible for the deaths of four people from fentanyl-related causes.

“Fentanyl is very addictive and very dangerous,” Beaumont DEA resident agent-in-charge Tim Duriso said of the opioid.

Duriso added that drugs like hydrocodone, Vicodin and Dilaudid are some of the most frequently abused prescription drugs common to the area.

“People are paying $40 per pill for some of these,” he remarked.

According to him, prescription drugs should only be used under the care of a physician.

“Anything like that not controlled by a doctor, under the care of a doctor, is always dangerous,” said Duriso.

Pure fentanyl can be deadly at very low doses, with the DEA reporting that two milligrams could cause a fatal overdose. Officers are warned in training courses to wear protective gear when handling the drug because even touching fentanyl in some forms is deadly. Fentanyl compounds come in several forms, including powder, blotter paper, tablets and spray.

Molfino said Southeast Texas itself is not fentanyl-free, as evidenced by the HFSC report, and he and a reformed addict who have been teaching local students about the perils of poor decision-making took their message on the road recently to educate youth about the dangers of drug use.

In parts of Maryland, Molfino said, the heroin epidemic is what is driving the many fentanyl-related overdoses there.

“Damon West and I went to Easton, Maryland, in Talbot County to talk to youth there about addiction because there is a heroin epidemic,” Molfino said. “Fentanyl use is related to that and is just as deadly.”

West is a Southeast Texas native and a former drug addict who got into methamphetamine in his 20s, leading the once-successful broker down a path to ruin. He was ultimately arrested for home burglaries in Dallas that he says he committed so he could buy drugs.

West has since cleaned up his act. Now out of jail and off drugs, he is working with Molfino to teach youth about the real consequences of narcotics and how to avoid placing oneself in perilous situations. West told his cautionary tale of addiction to thousands of attendees at the presentations in Easton, and learned about the devastation fentanyl wreaked in the small community.

“Hearing from parents who buried their children was, for lack of a better word, sobering,” West expressed. “Opiates and meth differ as epidemics because the former is unforgiving when you consume the wrong dose. Meth rarely kills its victims with quick overdoses; rather, it is a slow death with so many victims left in its wake.

“This town was burying their kids before they ever had a chance,” West said.

Talbot County Sheriff Deputy Lt. John Bollinger concurred.

“We definitely have a bit of a heroin issue here,” said Bollinger. “(Dealers) are cutting the heroin with fentanyl because it’s cheaper.”

Bollinger explained that heroin users are ingesting and shooting up the concoctions of heroin and fentanyl, generally without realizing the drugs have been combined, with fatal results.

“That’s what is causing them to stop breathing and their hearts to stop,” Bollinger asserted. “Fentanyl is causing a lot of the OD issues.”

Overdoses have become so common in the area, said Bollinger, officers have started carrying Narcan with them.

“Narcan is a drug that brings people out of an overdose,” Bollinger explained. “All of our deputies carry it. It’s very expensive, about $100 a dose, but it’s worth it.

“We didn’t have it in 2015, but in 2016 we have used Narcan 214 times.”

On the East Coast, said Bollinger, instances of non-fatal heroin overdoses went from 127 in 2015 to 333 so far in 2016. Fatal heroin overdoses increased from 19 to 40 during the same time period. Bollinger said the numbers of heroin overdoses include those related to heroin-fentanyl combinations. The U.S. Department of Health and Human Services (HHS) reports that drug overdose deaths are the leading cause of injury death in the United States. According to the Centers for Disease Control and Prevention (CDC), overdose deaths involving prescription opioids have quadrupled since 1999, and so have sales of those prescription drugs. From 1999 to 2014, the CDC estimates, more than 165,000 people have died in the U.S. from overdoses related to prescription opioids.

Molfino was adamant that, while Southeast Texas does not have the fentanyl fatalities of the East Coast, the Golden Triangle’s locale on the I-10 corridor ensures that the drug is in our communities. If someone is caught with fentanyl or other non-prescribed medications, they will be arrested, DEA agent Duriso warned, and the charges range from misdemeanors to felonies depending on the type of drug and quantity possessed.

“Charges for a schedule II drug are higher than charges for a schedule IV drug,” he explained. “And the more you have, the higher the charge.”

The higher the charge, added Duriso, the more potential jail time lawbreakers face.

Under federal sentencing guidelines, a person convicted of selling or attempting to sell fentanyl could face five to 20 years in prison, a $250,000 to $5 million fine, or both. If the defendant is convicted of selling or attempting to sell the drug near a school or other protected facility, the penalties double. And if anyone dies as a result of the drug sale, from overdose or otherwise, the dealer could face life in prison.

Jefferson County Investigator Molfino said education is vital in combating drug use. That’s why he and West traveled to Easton.

“I just got back,” he said Dec. 9. “We spoke to 10 groups, just about everyone in town. It is very important to reach out to people to talk about this epidemic. We want students to know they have options, and we want them to make the right choices.”

“When they see their friends doing it, sometimes it’s hard to say no,” he warned. “But this stuff is so dangerous. They should not be putting this into their bodies.”

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Editor's note: The term "Narcan" used by Deputy Bollinger refers to a trademark brand that is often used interchangeably with the generic form of the opioid overdose treatment product naloxone.

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